Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing

Figures & data

Figure 1. Percentage of patients receiving multiple naloxone administrations (MNA) in an EMS setting during 2012–15.

Figure 2. Multiple naloxone administrations (MNA) by U.S. census region in an EMS setting.

Table 1. Naloxone administration doses and population characteristics as reported by emergency medical service.

	Single Dose		Multiple Doses		Total within Category
	N	% Received	N	% Received	N	Percent
Age
0-19	5,944	83.4	1,181	16.6	7,125	4.1
20-29	26,806	79.0	7,146	21.1	33,952	19.6
30-49	46,287	79.9	11,627	20.1	57,914	33.5
50-64	36,382	82.9	7,482	17.1	43,864	25.4
65 plus	26,043	86.4	4,118	13.7	30,161	17.4
Gender
Female	59,459	83.1	12,113	16.9	71,572	41.4
Male	81,338	80.8	19,302	19.2	100,640	58.2
Unknown	665	82.7	139	17.3	804	0.5
US Region
Island Areas	6	75.0	2	25.0	8	0.0
Midwest	27,067	77.5	7,867	22.5	34,934	20.2
Northeast	24,967	76.3	7,764	23.7	32,731	18.9
South	66,759	87.0	9,954	13.0	76,713	44.3
West	22,663	79.2	5,967	20.8	28,630	16.5
Urbanicity
Unknown	4,820	79.5	1,240	20.5	6,060	3.5
Urban	113,747	81.2	26,284	18.8	140,031	80.9
Suburban	10,232	85.9	1,687	14.2	11,919	6.9
Wilderness	2,558	86.7	394	13.4	2,952	1.7
Rural	10,105	83.8	1,949	16.2	12,054	7.0
Location
Home/Residence	85,608	81.0	20,150	19.1	105,758	61.1
Other Location	11,413	81.0	2,676	19.0	14,089	8.1
Residential Institution (Nursing Home, jail/prison)	11,864	86.1	1,923	14.0	13,787	8.0
Street or Highway	16,890	84.0	3,208	16.0	20,098	11.6
Trade or service (business, bars, restaurants, etc)	8,690	82.2	1,886	17.8	10,576	6.1
Unknown	6,997	80.4	1,711	19.7	8,708	5.0
Weekend
Monday-Thursday	78,310	82.0	17,215	18.0	95,525	55.2
Friday-Sunday	63,152	81.5	14,339	18.5	77,491	44.8
Layperson
No Previous Naloxone	139,994	81.7	31,420	18.3	171,414	99.1
Previous Naloxone	1,468	91.6	134	8.4	1,602	0.9
Ambulance Service
ALS, Level 1	18,135	81.1	4,215	18.9	22,350	12.9
ALS, Level 1 Emergency	40,624	83.9	7,783	16.1	48,407	28.0
ALS, Level 2	11,401	77.0	3,415	23.1	14,816	8.6
BLS	223	88.1	30	11.9	253	0.1
BLS, Emergency	2,453	91.6	225	8.4	2,678	1.5
Unknown/Other	68,626	81.2	15,886	18.8	84,512	48.8
Oxygen
Not Provided	77,347	82.8	16,068	17.2	93,415	54.0
Provided	64,115	80.6	15,486	19.5	79,601	46.0
Disposition
Dead at Scene	4,529	88.6	581	11.4	5,110	3.0
Treated and Released	4,301	86.5	672	13.5	4,973	2.9
Treated, Transferred Care	4,957	81.7	1,114	18.4	6,071	3.5
Treated, Transported by EMS	127,583	81.4	29,177	18.6	156,760	90.6
Treated, Transported by Law Enforcement	57	90.5	6	9.5	63	0.0
Treated, Transported by Private Vehicle	35	89.7	4	10.3	39	0.0

Source: National EMS Information, 2015.

Table 2. Naloxone administration doses and population characteristics as reported by emergency.

	Odds Ratio Estimate	Lower CI	Upper CI
Gender
Female	1.00	–	–
Male	1.13	1.10	1.16
Unknown	1.13	0.94	1.37
Age
ages 0–19	1.00	–	–
ages 20–29	1.29	1.21	1.39
ages 30–49	1.27	1.18	1.35
ages 50–64	1.05	0.98	1.12
ages 65 plus	0.84	0.78	0.91
Region
Midwest	1.00	–	–
Island Areas	1.39	0.28	7.02
Northeast	1.18	1.13	1.22
South	0.53	0.51	0.55
West	0.99	0.95	1.03
Urbanicity
Urban	1.00
Rural	0.85	0.80	0.89
Suburban	0.76	0.72	0.80
Wilderness	0.76	0.68	0.84
Unknown	1.12	1.05	1.19
Weekend
Monday-Thursday	1.00	–	–
Friday-Sunday	1.02	0.99	1.04
Layperson Administration
No Previous Naloxone	1.00	–	–
Previous Naloxone	0.55	0.46	0.65
Location
Street or Highway	1.00	–	–
Home/Residence	1.42	1.36	1.48
Other Location	1.26	1.19	1.33
Residential Institution (Nursing Home, jail/prison)	1.12	1.05	1.19
Trade or service (business, bars, restaurants, etc)	1.22	1.14	1.30
Unknown	1.42	1.33	1.52
Dispatch Complaint
Other	1.00	–	–
Ingestion/Poisoning	1.12	1.09	1.16
Unknown	1.00	0.97	1.03
Ambulance Service Level
BLS	1.00	–	–
BLS Emergency	0.45	0.30	0.68
ALS, Level 1	1.58	1.07	2.32
ALS, Level 1, Emergency	1.15	0.78	1.69
ALS, Level 2	2.15	1.45	3.16
Unknown\Other	1.46	0.99	2.15
Oxygen
Provided	1.00	–	–
Not Provided	0.84	0.82	0.86
Primary Symptom
None	1.00	–	–
Bleeding	0.75	0.52	1.07
Breathing Problem	1.41	1.25	1.59
Change in responsiveness	1.28	1.15	1.43
Choking	0.97	0.56	1.68
Death	0.76	0.67	0.86
Device/Equipment Problem	<0.001	-	-
Diarrhea	2.41	0.96	6.03
Drainage/Discharge	1.72	0.61	4.89
Fever	1.51	0.90	2.53
Malaise	0.70	0.55	0.88
Mass/Lesion	<0.001	-	-
Mental/Psych	0.93	0.81	1.07
Nausea/Vomiting	0.59	0.46	0.78
Pain	0.87	0.74	1.02
Palpitations	0.83	0.52	1.33
Rash/Itching	0.28	0.04	2.13
Swelling	1.12	0.38	3.32
Transport Only	0.73	0.44	1.21
Unknown	1.06	0.95	1.19
Weakness	0.82	0.71	0.96
Wound	0.85	0.57	1.27
Disposition
Dead at the Scene	1.00	–	–
Treated and Released	1.09	0.96	1.23
Treated, Transferred Care	1.44	1.29	1.61
Treated, Transported by EMS	1.61	1.47	1.76
Treated, Transported by Law Enforcement	0.78	0.33	1.84
Treated, Transported by Private Vehicle	0.90	0.32	2.57

Source: National EMS Information, 2015.